How Much Does 24-Hour Home Care Cost, and What Will Medicare Pay?

Your mom came home from the hospital. The nights are the problem. She gets up confused, and someone has to be there. So you start pricing round-the-clock help, and the numbers are bigger than you expected.

I'm an occupational therapist, and I've worked in home health. Families ask me this question more than almost any other: what does 24-hour care cost, and what will Medicare pay?

Below, a rule means a federal rule, and I'll cite it. A price comes from a named survey, and I'll say which one and what year. Anything labelled "my advice" is my own opinion, not a rule.

What home care costs per hour

The best national price survey I found is CareScout's Cost of Care Survey. CareScout's page still calls it "The Genworth Cost of Care Survey" in one place. It says: "We've conducted this survey for 20+ years."

For 2025, it reports a national median for a non-medical caregiver of $35 an hour, up 3% from $34 in 2024. Its page says: "The national median hourly rate for non-medical caregiver services increased to $35 per hour, reflecting a 3% year-over-year increase."

Here is how it defines that worker. A non-medical caregiver "Includes a home health aide providing in-home assistance with performing activities of daily living, such as help with bathing, dressing, transferring and toileting that does not require more specialized care." It adds that this "can also include homemaker services." The survey now reports these together: "homemaker and home health aide services are now collectively classified as "non-medical caregiver.""

Where the number comes from. The survey ran "From July through November 2025." CareScout says it "contacted 211,985 long-term care providers by phone and email to complete approximately 16,000 surveys," with "home health care providers, resulting in 6,014 completed surveys." These are prices providers reported, not wages.

Two limits on that number. First, it is a median across the country. CareScout says: "The cost for any particular provider may differ significantly from the median cost of care for similar providers in your location." Second, it is not a quote. Your local agency may charge more or less.

CareScout also lists skilled nursing in the home at a national median of $90 an hour in 2025. CareScout calls this a "Private Duty Nurse." That is a different thing from Medicare home health visits.

A note on wages versus prices. What the family pays an agency is a price. What the caregiver earns is a wage, and it is lower. Federal wage data from the Bureau of Labor Statistics measures the second, so it does not answer your question. I did not use it here.

The arithmetic for 24 hours

CareScout's own headline figure assumes 44 hours a week. Its page explains why: "CareScout has followed industry guidance with representing 44 hours as the estimated number of hours per week for professional in-home caregivers." At that default, it reports an annual cost of $80,080.

Round-the-clock care is 168 hours a week. CareScout's tool lets you set the hours up to that maximum ("24 hours of care / 7 days a week"), but I did not see a published price for 24-hour care, so the table below is my own multiplication, not a survey result.

That is arithmetic: $35 x 24 for a day, then the day x 7 for a week and x 30 for a month. It assumes every hour is billed at the same median rate. No source I fetched says how agencies price live-in arrangements or overnight hours. That is why one of the questions below is about exactly that.

Your real number could be lower or higher. It depends on where you live, the agency, and whether the hours are billed the same all day and night.

What Medicare pays toward it

Short answer: not the 24 hours.

Medicare's booklet Medicare & Home Health Care (CMS Product No. 10969, July 2025) lists what Medicare doesn't pay for under the home health benefit:

• "24-hour-a-day care at home"
• "Meals delivered to your home"
• "Services like shopping, cleaning, and laundry"
• "Custodial or personal care like bathing, dressing, and using the bathroom (when this is the only care you need)"

Medicare.gov's long-term care page says it more bluntly: "You pay all costs for non-covered services, including most long-term care." Our guide to what home health does not cover goes through that list. Our guide to home health, home care and hospice explains how the three differ.

What Medicare does cover is part-time

Home health under Medicare is visits. The Medicare Benefit Policy Manual (chapter 7, §50.7) defines the limit. It quotes the statute: "the term "part-time or intermittent services" means skilled nursing and home health aide services furnished any number of days per week as long as they are furnished (combined) less than 8 hours each day and 28 or fewer hours each week (or, subject to review on a case-by-case basis as to the need for care, less than 8 hours each day and 35 or fewer hours each week)."

Note the wording. The text says "less than 8 hours" each day.

Do the math against the table. Even at the 28-hour ceiling, the other 140 hours of a 168-hour week are not covered. At $35 an hour, those 140 hours come to $4,900 a week. That is arithmetic. And 28 is a ceiling. The visits are the ones ordered in the plan of care, and in my experience most people get far fewer hours.

Medicare plus a paid caregiver

Here is the part families miss. The manual does not stop you from paying for extra hours while Medicare covers its part. Section 50.7.1 says: "Home health aide and/or skilled nursing care, in excess of the amounts of care that meet the definition of part-time or intermittent, may be provided to a home care patient or purchased by other payers without bearing on whether the home health aide and skilled nursing care meets the Medicare definitions of part-time or intermittent."

The manual's own example is a patient who needs skilled nursing monthly for a catheter change and also needs a home health aide 24 hours a day. Medicare pays for the visits within the weekly limit. The agency "bills the beneficiary (or another payer) for the remainder of the care."

Two cautions about that example. It is a case where the patient already qualifies for home health because of skilled nursing. Someone who needs only an aide is not in that example. For nursing there is one more limit. Section 50.7.2 says extra nursing hours leave Medicare coverage alone only when your parent also needs therapy. A parent who qualifies on nursing alone must still need nursing only intermittently. And the manual adds that the 35 hours are covered only if the Medicare contractor determines they are reasonable and necessary. To see whether your parent qualifies at all, start with who qualifies for home health care. What your parent pays for the covered visits is in Medicare home health costs.

Who else may pay

None of these is a sure thing. Each has its own rules, and I describe only what the sources say.

• Medicaid. Medicare.gov says that although you aren't eligible for long-term care under Medicare, "you may be eligible for it through Medicaid (if you meet eligibility requirements in your state)." The federal rule on Medicaid home or community-based waiver services (42 CFR §440.180(b)) says those services may include homemaker services, home health aide services and personal care services, as each state defines them and CMS approves. What your state offers, and how many hours, is a call to your state Medicaid office.
• The VA. For veterans, the VA has a Homemaker and Home Health Aide program. I cover who qualifies in our VA home health aide article.
• Long-term care insurance. Medicare.gov says you can "buy private long-term care insurance." If your parent has a policy, call the insurer and ask what it pays and how to start a claim.
• PACE. Medicare.gov describes PACE as "a Medicare and/or Medicaid comprehensive medical and social services program available in some states." It "covers all Medicare- and Medicaid-covered care and services, and anything else the health care professionals in your PACE team decide you need." To join, a person must be at least 55, live in the service area, "Need a nursing home-level of care (as certified by your state)," and be able to live safely in the community with help from PACE. Medicare.gov says: "The PACE program is only available in some states that offer PACE under Medicaid."

My advice for families

Everything in this section is my practice advice, not a Medicare rule.

Start by asking whether you need all 24 hours. Is your parent unsafe alone at night, or would a phone check and a few daytime visits do? The doctor and the therapist who saw your parent at home can tell you what they saw. Ask them directly.

Use home health for the skilled part, and pay for the rest as needed. In my experience, families often build a week like this. Home health nurses and therapists come on the days the plan of care sets. A paid caregiver covers the hours Medicare won't, often the mornings, evenings or nights that matter most. Family fills the gaps. As your parent gets stronger and home health ends, the paid hours can often shrink.

Ask the home health team what your parent can do alone. A therapist's job is to get your parent safer. A bed alarm, grab bars, a bedside commode or a better transfer technique may change how many paid hours you need. Our guide on home exercises when the therapist isn't there helps with the practice part.

What I'd ask a home care agency about price

1. What is the hourly rate, and is it the same for nights, weekends and holidays?
2. Is there a minimum shift length? What do you charge for a short visit?
3. How do you charge for overnight hours when my parent is asleep and the caregiver is on site?
4. For 24 hours a day, would one caregiver stay, or will several rotate? How is that priced?
5. Are your caregivers your employees? Do you handle their taxes and insurance, or do I?
6. What happens if a caregiver calls out? Who covers the shift, and at what rate?
7. How much notice do you need to change or cancel hours? Is there a deposit?
8. Will you give me the rates and terms in writing before we start?

I would get two or three quotes. Prices vary, and the answers to those questions tell you more than the hourly rate does.

Frequently asked questions

How much does 24-hour home care cost per month?

No survey I found prices 24-hour care as a single figure. CareScout's 2025 survey puts the national median for a non-medical caregiver at $35 an hour. As arithmetic only, $35 x 24 hours x 30 days is $25,200 a month. Your local rate, and how the agency charges for overnight hours, will change that.

What does Medicare pay toward 24-hour care?

Only the part-time home health share, and only if your parent qualifies: nursing and aide time combined of under 8 hours a day and 28 or fewer hours a week, or up to 35 in some limited situations. Medicare's home health booklet lists 24-hour-a-day care at home as something Medicare doesn't pay for, so the rest of the day is paid some other way.

Can my parent have Medicare home health and a paid caregiver at the same time?

Yes. Medicare's manual says care beyond the part-time limits can be purchased by other payers without affecting whether the Medicare-covered care qualifies. Your parent still has to qualify for home health on their own, and Medicare pays only for the covered visits.

Who else might help pay for round-the-clock care?

Depending on the person, Medicaid home and community-based services, depending on your state's rules, a VA program for some veterans, long-term care insurance if your parent has a policy, or PACE where it is offered. Each has its own eligibility rules, so ask each one directly.

Sources

• Cost of Care Survey, 2025 national medians and methodology (CareScout)
• Medicare Benefit Policy Manual, Chapter 7, Home Health Services, §50.7 and §50.7.1 (CMS)
• Medicare & Home Health Care, CMS Product No. 10969, July 2025 (Medicare.gov)
• Long-term care coverage (Medicare.gov)
• PACE (Medicare.gov)
• 42 CFR §440.180, Home and community-based waiver services (Cornell LII)